The margins of the removed lesion were found to be negative for cancerous cells, and doctors believed that the cancer was not invasive to the patient’s pancreas. This result prompted doctors to order a 6-month period of observation of the patient’s condition, primarily through the use of upper gastrointestinal endoscopy as well as ultrasound. Though the course of this observation period, the patient underwent multiple endoscopies, all of which were negative for suspicious lesions, however the doctor did not order any ultrasounds during the observation period. One year after the conclusion of the observation period for the initial lesion, the patient was diagnosed with a mass in the head of his pancreas, which necessitated a Whipple procedure and left the patient with a grim prognosis.
Question(s) For Expert Witness
1. Can you determine whether surveillance of the pancreas by the means described above is the standard of care?
Expert Witness Response E-000029
Surveillance of the pancreas by upper endoscopic ultrasound for total ampullectomy for this type of cancer, which is resected with negative margins indicated is within reasonable practice, which includes blood studies, chest radiograph, and a CT scan of the abdomen and/or pelvis every 6 months. Most of the literature suggests CT scan, not ultrasound, for additional monitoring. The National Comprehensive Cancer Network recommends it on PANC-6 category 2B recommendation, which means there is some disagreement among experts on this topic. I am certainly capable of determining whether the blood tests for the pancreatic enzymes and cancer markers, CEA and CA-19-9 is indicated and is the standard of care in such a patient. The National Comprehensive Cancer Network recommends Ca 19-9 (Panc-6) Category 2B for completely resected cancers. Regarding the percentage of loss of body weight that should have prompted an upper endoscopic ultrasound, literature says that unintended weight loss of 5-10% is an indication for an evaluation. For cancer patients in remission, I would support 5%.
About the author
Wendy Ketner, M.D.
Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.
Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.
Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.
